Background & aims: Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent and increasingly recognized as a multisystem cardiometabolic disorder. The global burden, incidence and prognostic implications of coexisting chronic kidney disease (CKD) in MASLD remain uncertain.
Methods: In this meta-analysis, we searched MEDLINE and EMBASE from inception through September 25, 2025, for observational studies reporting CKD prevalence and/or incidence among adults (≥ 18 years) with MASLD. The primary outcomes were pooled CKD prevalence, estimated using random-effects models on the logit scale with the Hartung-Knapp adjustment, and pooled CKD incidence (per 1000 person-years), estimated using random-effects models with exact Poisson confidence intervals. Secondary outcomes included all-cause mortality and cardiovascular, renal and cancer outcomes.
Results: From 2811 records, 36 observational studies met the inclusion criteria. Twenty-three studies contributed prevalence estimates (575 615 participants; 56 248 CKD cases) and thirteen studies contributed incidence estimates (27 996 new events). The pooled global CKD prevalence among individuals with MASLD was 15.22% (95% CI 9.69-23.12). The pooled CKD incidence was 22.17 per 1000 person-years (95% CI 11.44-32.89) in the MASLD population. Hypertension (OR 1.49, 95% CI 1.29-1.72), dyslipidaemia (OR 1.22, 95% CI 1.20-1.24) and diabetes (OR 1.94, 95% CI 1.69-2.22) were associated with higher odds of CKD in the MASLD population. All-cause mortality rates were 18.28 per 1000 person-years (95% CI 3.45-33.11) in coexistent MASLD and CKD, more than double those in the MASLD-only population (7.26 per 1000 person-years (95% CI 2.97-11.56)).
Conclusions: Coexistent CKD affects one in seven individuals with MASLD worldwide, conferring a more than two-fold increased risk of all-cause mortality compared with individuals with MASLD alone.
Keywords: MASLD; chronic kidney disease; epidemiology; steatotic liver disease.
Individuals with metabolic dysfunction‐associated steatotic liver disease (MASLD) appear to have a greater burden of chronic kidney disease (CKD), particularly in the presence of cardiometabolic conditions such as diabetes, hypertension and dyslipidaemia. In this study, individuals with coexisting MASLD and CKD experienced higher rates of death and cardiovascular complications compared with those with MASLD alone, supporting the need for earlier kidney assessment and integrated cardiometabolic care in this high‐risk population.
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